Basic Information
| Provider Information | |||||||||
| NPI: | 1407106883 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNNYSIDE COMMUNITY HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VALLEY REGIONAL BONE AND JOINT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 719 | ||||||||
| Address2: | |||||||||
| City: | SUNNYSIDE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989440719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098371617 | ||||||||
| FaxNumber: | 5098374908 | ||||||||
| Practice Location | |||||||||
| Address1: | 1413 EAST EDISON AVE. | ||||||||
| Address2: | |||||||||
| City: | SUNNYSIDE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989441622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098371617 | ||||||||
| FaxNumber: | 5098374908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2012 | ||||||||
| LastUpdateDate: | 02/04/2019 | ||||||||
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| AuthorizedOfficialLastName: | ROWAN | ||||||||
| AuthorizedOfficialFirstName: | CARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5098371655 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SUNNYSIDE COMMUNITY HOSPITAL | ||||||||
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| AuthorizedOfficialCredential: | C.F.O | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.